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  • It may not be surprising that the neural pathways in depression and (persistent) pain are partially similar.

    And to "quote" Sapolsky: "this screams biology" and is not due to psychological or emotional weakness or failure etc. which would apply to (persistent) pain too.
    Marcel

    "Evolution is a tinkerer not an engineer" F.Jacob
    "Without imperfection neither you nor I would exist" Stephen Hawking

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    • So back to my original reason for bringing this up. How do we help? Can we help? Before we jump on the band wagon of "yes we can; PT 1st!" Is our benefit outweighed by the effect size, time, money, sacrifice of attending or seeing a physical therapist?
      "The views expressed here are my own and do not reflect the views of my employer."

      Comment


      • FrustratedNewGrad
        FrustratedNewGrad commented
        Editing a comment
        Johnny, I'm curious as to what your evaluation looks like. If someone comes in with say a diagnosis of "shoulder impingement", what happens in your evaluation? What are you looking at? What is your treatment?

    • How do we help? Can we help?
      It depends on what your work situation permits you to do.

      Much of my work consists of a lot of dialogue and a bit of manual cueing. An increasing number of my colleagues are hands off.

      A sizeable contingent of my new referrals are those who have failed elsewhere. They want to know if it is possible to return to work, performance, sport, family life and if it is deemed possible, what it will take to get there. If a letter has been written it requests "opinion and management". It is sometimes my opinion that they would be better managed by someone else.


      "yes we can; PT 1st!"
      Is the PT an autonomous practitioner? Or are they delivering a service prescribed by someone else? If the latter pertains, then whoever prescribed or suggested PT is 1st. If the PT is being backseat driven by the insurance company, then they are 1st
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • FNG,

        Once I've completed all the irrelevant check-offs of EMR and required gobbly-gook...

        I like to keep things simple:
        Red light: non-MSK and referral warranted: CV, respiratory, trauma related etc
        Yellow light: Psychosocial stuff, PCS, FABQ, etc stuff: make a mental note as this will impact my interaction and education, maybe a referral
        Green light: mechanical/MSK-like.

        Differential: Cervical radiculopathy, cervical with somatic referral, thoracic issue, shoulder issue (doesn't matter to me the exact "tissue issue".)

        Intervention based on limitations, ADL/work/sport requirements. Maybe address work/rest ratio, acute/chronic workload. If lacking movement, offer range of motion, if pain trial isometrics, if weak get it stronger.

        and education, education, education

        How's that?
        Last edited by Johnny_Nada; 12-12-2017, 04:44 AM.
        "The views expressed here are my own and do not reflect the views of my employer."

        Comment


        • FrustratedNewGrad
          FrustratedNewGrad commented
          Editing a comment
          Do you take out your goniometer, perform MMTs, special tests etc?

      • Goniometer and MMT's come out based on insurance requirements. Special tests: painful arc, drop arm, shoulder abduction sign, Wainner cluster for CR, myo/dermo/DTR's. Most can be done in a basic movement assessment and don't require much in the way of addition "stuff."

        I primarily care about what the patient cares about: "it hurts when I do this or need to do this." I do that.

        How's that?
        "The views expressed here are my own and do not reflect the views of my employer."

        Comment


        • FrustratedNewGrad
          FrustratedNewGrad commented
          Editing a comment
          Don't mean to be annoying, I'm just genuinely curious. Say the Wainner cluster is positive and this patient has a cervical radiculopathy. What evidence says PT is effective at relieving CR? What is your treatment? Just education?

      • FNG,

        no worries. Here is a nice infographic.
        http://www.chrisworsfold.com/cervica...y-infographic/

        So yes, I give education letting them know it gets better. They can just continue as is and it will likely improve. If they want to see me, then I'll typically follow what the infographic says. I do use traction (GASP!!!). SHHH! Don't tell anyone.

        Here are some references for you. Yes I know: CPR's; oh the humanity!!!

        Raney, Nicole H., et al. "Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise." European Spine Journal 18.3 (2009): 382-391.

        Fritz, Julie M., et al. "Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial." journal of orthopaedic & sports physical therapy44.2 (2014): 45-57.

        A few more references for you regarding a more multimodal approach.

        Cleland, Joshua A., et al. "Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series." Journal of Orthopaedic & Sports Physical Therapy 35.12 (2005): 802-811

        Young, Ian A., et al. "Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial." Physical therapy 89.7 (2009): 632-642.

        "The views expressed here are my own and do not reflect the views of my employer."

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        •  
          "The views expressed here are my own and do not reflect the views of my employer."

          Comment


          • Overheard today,

            "She has used up her insurance allowance for the year"

            as they discuss a client who has been thouroughly pathologized and spun into circles about what is happening in her body. She used it.

            Sometimes I can't even stop the headshaking
            Chad Hardin PT, GCFP

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            • "She" used up her insurance. It's "her" fault.....sigh....
              "The views expressed here are my own and do not reflect the views of my employer."

              Comment


              • Yes, yes it does. Its about time someone said it.

                https://lauraopstedal.wordpress.com/...acl-injuries/b
                "The views expressed here are my own and do not reflect the views of my employer."

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